Provider Demographics
NPI:1518400829
Name:DAVIS, LASHONDRA (CMA, EMT)
Entity type:Individual
Prefix:
First Name:LASHONDRA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CMA, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-6304
Mailing Address - Country:US
Mailing Address - Phone:217-685-9092
Mailing Address - Fax:
Practice Address - Street 1:812 N 6TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-6304
Practice Address - Country:US
Practice Address - Phone:217-685-9092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide